Citation Information :
Montero JF, de Souza HC, Martins MS, Oliveira MN, Benfatti CA, Magini RD. Versatility and Importance of Bichat's Fat Pad in Dentistry: Case Reports of Its Use in Occlusal Trauma. J Contemp Dent Pract 2018; 19 (7):888-894.
Introduction: The knowledge of the anatomy surrounding Bichat's fat pad, as well as its clinical applications, is essential to indicate and to safely perform its removal. This surgery is indicated not only for esthetic purposes, but also for functional reasons. When used properly, Bichat's fat pad is composed of stem cells that have a similar phenotype to adipose stem cells, useful in the treatment of pathologies and/or complications, such as maxillary sinus membrane perforation, oroantral/oronasal communications, peri-implantitis, ulcers, fibrosis of the oral mucosa, soft tissue reconstruction, among others. Due to its location, it is prone to suffer clinically significant pathologies, as well as constant trauma.
Aim: The aim of this study is to report two clinical cases and subsequent follow-ups, where bichectomy was performed to avoid dental trauma to mucosal tissues during the masticatory function. Also, literature review on the application of Bichat's fat pad in dentistry is provided.
Case report: Two female patients (20 and 24 years) reported discomfort and constant pain in the oral mucosa caused by dental trauma. At the clinical examination, patient presented augmented and injured mucosa. The surgical sequence of Bichat's fat pad removal, as well as the extra-/intraoral photographic follow-up (8, 15, 30, and 180 days) of the patients is described.
Conclusion: In order to indicate and/or accomplish surgical procedures involving Bichat's fat pad, it is fundamental to know its anatomy and possible applications, not only for esthetic purposes, but also for functional purposes. The patients showed evident improvements following the removal of Bichat's fat pad.
Clinical significance: Application of Bichat's fat and its removal should be evaluated, being an alternative in patients who constantly undergo mucosal injury during masticatory function.
Zipfel TE, Street DF, Gibson WS, Wood WE. Traumatic herniation of the buccal fat pad: a report of two cases and a review of the literature. Int J Pediatr Otorhinolaryngol 1996 Dec;38(2):175-179.
Yousuf S, Tubbs RS, Wartmann CT, Kapos T, Cohen-Gadol AA, Loukas M. A review of the gross anatomy, functions, pathology, and clinical uses of the buccal fat pad. Surg Radiol Anat 2010 Jun;32(5):427-436.
Aldridge T, Thomson A, Ilankovan V. Abnormal anatomy of inferior orbital fissure and herniation of buccal fat pad. Br J Oral Maxillofac Surg 2015 Jan;53(1):92-93.
Farré-Guasch E, Martí-Pagè C, Hernádez-Alfaro F, Klein- Nulend J, Casals N. Buccal fat pad, an oral access source of human adipose stem cells with potential for osteochondral tissue engineering: an in vitro study. Tissue Eng Part C Methods 2010 Oct;16(5):1083-1094.
Bande C, Dawane P, Gupta MK, Gawande M, Rode V. Immediate versus delayed aggressive physical therapy following buccal fat pad interposition in oral submucous fibrosis—a prospective study in Central India. Oral Maxillofac Surg 2016 Dec;20(4):397-403.
Lambade P, Dawane P, Thorat A. Efficacy of buccal fat pad in the surgical management of oral submucous fibrosis: a prospective study. Oral Maxillofac Surg 2016 Jun;20(2): 167-170.
Kim MK, Han W, Kim SG. The use of the buccal fat pad flap for oral reconstruction. Maxillofac Plast Reconstr Surg 2017 Feb;39(1):5.
Egyedi P. Utilization of the buccal fat pad for closure of oroantral and/or oro-nasal communications. J Maxillofac Surg 1977 Nov;5(4):241-244.
Zhang HM, Yan YP, Qi KM, Wang JQ, Liu ZF. Anatomical structure of the buccal fat pad and its clinical adaptations. Plast Reconstr Surg 2002 Jun;109(7):2509-2518.
Loukas M, Kapos T, Louis RG Jr, Wartman C, Jones A, Hallner B. Gross anatomical, CT and MRI analyses of the buccal fat pad with special emphasis on volumetric variations. Surg Radiol Anat 2006 Jun;28(3):254-260.
Kim SY, Alfafara A, Kim JW, Kim SJ. Traumatic buccal fat pad herniation in young children: a systematic review and case report. J Oral Maxillofac Surg 2017 Sep;75(9):1926-1931.
Khadilkar AS, Goyal A, Gauba K. The enigma of “Traumatic Pseudolipoma” and “Traumatic Herniation of Buccal Fat Pad”: a systematic review and new classification system of post-traumatic craniofacial fatty masses. J Oral Maxillofac Surg 2018 Jun;76(6):1267-1278.
Galletti C, Cammaroto G, Galletti F, Camps-Font O, Gay-Escoda C, Bara-Casaus JJ. Dental implants after the use of bichat's buccal fat pad for the sealing of oro-antral communications. A case report and literature review. J Clin Exp Dent 2016 Dec;8(5):e645-e649.
Abad-Gallegos M, Figueiredo R, Rodríguez-Baeza A, Gay- Escoda C. Use of Bichat's buccal fat pad for the sealing of orosinusal communications. A presentation of 8 cases. Med Oral Patol Oral Cir Bucal 2011 Mar;16(2):e215-e219.
Matarasso A. Managing the buccal fat pad. Aesthetic Surg J 2006 May-Jun;26(3):330-336.
Hasse FM, Lemperle G. Resection and augmentation of Bichat's fat pad in facial contouring. Eur J Plast Surg 1994 Sep;17(5):239-242.
Altman K. Facial feminization surgery: current state of the art. Int J Oral Maxillofac Surg 2012 Aug;41(8):885-894.
Muñoz-Corcuera M, Esparza-Gómez G, González-Moles MA, Bascones-Martínez A. Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers. Clin Exp Dermatol 2009 Apr;34(3):289-294.
Falah M, Srouji S. Use of buccal fat pad for closure of perforation and graft material in a maxillary sinus elevation procedure: a preliminary study. Int J Oral Maxillofac Implants 2016 Jul-Aug;31(4):842-848.
Panda S, Del Fabbro M, Satpathy A, Das AC. Pedicled buccal fat pad graft for root coverage in severe gingival recession defect. J Indian Soc Periodontol 2016 Mar-Apr;20(2):216-219.
de Moraes EJ. The buccal fat pad flap: an option to prevent and treat complications regarding complex zygomatic implant surgery. Preliminary report. Int J Oral Maxillofac Implants 2012 Jul-Aug;27(4):905-910.
Peñarrocha-Diago M, Alonso-González R, Aloy-Prósper A, Peñarrocha-Oltra D, Camacho F, Peñarrocha-Diago M. Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study. Med Oral Patol Oral Cir Bucal 2015 Nov;20(6):e699-e706.
Kablan F. The use of Buccal fat pad free graft in regenerative treatment of peri-implantitis: A new and predictable technique. Ann Maxillofac Surg 2015 Jul-Dec;5(2):179-184.